﻿<%@ Page Title="" Language="C#" MasterPageFile="~/Site.Master" AutoEventWireup="true" CodeBehind="RegisterPatient.aspx.cs" Inherits="Internet_Deliver_Therapy.Views.Admin.Patient.RegisterPatient" %>
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    <h1>E-LEARNING REGISTRATION</h1>
    <p>Page 1 of 3</p>
    <article>
     <p class="text-danger">
        <asp:Literal runat="server" ID="ErrorMessage" />
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    <asp:ValidationSummary runat="server" CssClass="text-danger" />
    <asp:Table ID="Table1" runat="server" Width="1100px">
        <asp:TableRow>
            <asp:TableCell>
                <asp:Label ID="Label1" runat="server" Text="First Name (Given Name)*"></asp:Label><asp:TextBox ID="tbFirstName" runat="server" Text="Eileen"></asp:TextBox>
                <asp:RequiredFieldValidator runat="server" ControlToValidate="tbFirstName" CssClass="text-danger" ErrorMessage="The First Name field is required." />
            </asp:TableCell>
            <asp:TableCell>
                <asp:Label ID="Label2" runat="server" Text="Gender*"></asp:Label><asp:DropDownList ID="ddlGender" runat="server" />
            </asp:TableCell>
        </asp:TableRow>
        <asp:TableRow>
            <asp:TableCell>    
                <asp:Label ID="Label3" runat="server" Text="Last Name (Surname)*"></asp:Label><asp:TextBox ID="tbLastName" runat="server" Text="Tan"></asp:TextBox>
                <asp:RequiredFieldValidator runat="server" ControlToValidate="tbLastName" CssClass="text-danger" ErrorMessage="The Last Name field is required." />
            </asp:TableCell>
            <asp:TableCell>
                <asp:Label ID="Label4" runat="server" Text="Race*"></asp:Label><asp:TextBox ID="tbRace" runat="server" Text="Chinese"></asp:TextBox>
                <asp:RequiredFieldValidator runat="server" ControlToValidate="tbRace" CssClass="text-danger" ErrorMessage="The Race field is required." />
            </asp:TableCell>
        </asp:TableRow>
        <asp:TableRow>
            <asp:TableCell>    
                <asp:Label ID="Label5" runat="server" Text="NRIC/Fin*"></asp:Label><asp:TextBox ID="tbNRIC" runat="server" Text="S0987654C"></asp:TextBox>
                <asp:RequiredFieldValidator runat="server" ControlToValidate="tbNRIC" CssClass="text-danger" ErrorMessage="The NRIC/Fin field is required." />
            </asp:TableCell>
            <asp:TableCell>
                <asp:Label ID="Label6" runat="server" Text="Birth Date*"></asp:Label><select id="daydropdown" name="daydropdown"></select><select id="monthdropdown" name="monthdropdown"></select><select id="yeardropdown" name="yeardropdown"></select>
                <script type="text/javascript">
                    window.onload = function () {
                        populatedropdown("daydropdown", "monthdropdown", "yeardropdown")
                    }
                </script>
            </asp:TableCell>
        </asp:TableRow>
        <asp:TableRow>
            <asp:TableCell>    
                <asp:Label ID="Label7" runat="server" Text="Mobile No.*"></asp:Label><asp:TextBox ID="tbMobileNo" runat="server" Text="91234567"></asp:TextBox>
                <asp:RequiredFieldValidator runat="server" ControlToValidate="tbMobileNo" CssClass="text-danger" ErrorMessage="The Mobile No. field is required." />
            </asp:TableCell>
            <asp:TableCell>
                <asp:Label ID="Label8" runat="server" Text="Home No."></asp:Label><asp:TextBox ID="tbHomeNo" runat="server" Text="61234567"></asp:TextBox>
            </asp:TableCell>
        </asp:TableRow>
        <asp:TableRow>
            <asp:TableCell>
                <asp:Label ID="Label9" runat="server" Text="Email Address*"></asp:Label><asp:TextBox ID="tbEmail" runat="server" Text="eileen@gmail.com"></asp:TextBox>
                <asp:RequiredFieldValidator runat="server" ControlToValidate="tbEmail" CssClass="text-danger" ErrorMessage="The Email field is required." />
                <asp:RegularExpressionValidator runat="server" ControlToValidate="tbEmail" CssClass="text-danger" Display="Dynamic" 
                    ValidationExpression="\w+([-+.]\w+)*@\w+([-.]\w+)*\.\w+([-.]\w+)*" ErrorMessage="Please enter a valid Email" />
            </asp:TableCell>
        </asp:TableRow>
        <asp:TableRow>
            <asp:TableCell>
                <asp:Label ID="Label10" runat="server" Text="Password*"></asp:Label><asp:TextBox ID="tbPassword" runat="server" TextMode="Password"></asp:TextBox>
                <asp:RequiredFieldValidator runat="server" ControlToValidate="tbPassword" CssClass="text-danger" ErrorMessage="The Password field is required." />
                <asp:RegularExpressionValidator runat="server" ControlToValidate="tbPassword" CssClass="text-danger" Display="Dynamic"
                    ValidationExpression="(?=^.{6,}$)(?=(?:.*?\d){1})(?=.*[a-z])(?=(?:.*?[!@#$%*()_+^&}{:;?.]){1})(?!.*\s)[0-9a-zA-Z!@#$%*()_+^&]*$"
                    ErrorMessage="Please enter at least 6 characters consisting of at least 1 alphabet, 1 number & 1 special character" />
            </asp:TableCell>
        </asp:TableRow>
        <asp:TableRow>
            <asp:TableCell>
                <asp:Label ID="Label11" runat="server" Text="Confirm Password*"></asp:Label><asp:TextBox ID="tbConfirmPw" runat="server" TextMode="Password"></asp:TextBox>
                <asp:RequiredFieldValidator runat="server" ControlToValidate="tbConfirmPw" CssClass="text-danger" ErrorMessage="The Confirm Password field is required." />
                <asp:CompareValidator runat="server" ControlToCompare="tbPassword" ControlToValidate="tbConfirmPw"
                    CssClass="text-danger" Display="Dynamic" ErrorMessage="The password and confirmation password do not match." />
            </asp:TableCell>
        </asp:TableRow>
        <asp:TableRow>
            <asp:TableCell>
                Let us know if you prefer to receive notification via*
                <asp:RadioButtonList ID="rbNotifyVia" runat="server" vertical-Align="baseline" RepeatDirection="horizontal" TextAlign="right" RepeatLayout="Table" width="10px"  >
                  <asp:ListItem Value="Email" Text="Email" Selected="True"></asp:ListItem>
                  <asp:ListItem Value="SMS" Text="SMS"></asp:ListItem>
                </asp:RadioButtonList>        
            </asp:TableCell>
        </asp:TableRow>
        <asp:TableRow>
            <asp:TableCell>
                <asp:CheckBox ID="cbNews" runat="server" />Let us know if you like to opt in for THRIVE eNewsletter. <br />
                    &nbsp;&nbsp;&nbsp;&nbsp;The information that you provide is to help improve the THRIVE Program and to track your learning progress.
            </asp:TableCell>
            <asp:TableCell>
                &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<asp:Button ID="btnBack" runat="server" Text="Back" onClick ="Back_Click"/>&nbsp;&nbsp;&nbsp;&nbsp;<asp:Button ID="btnNext" runat="server" Text="Next" onClick="Validate_Click"/>
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    </article>
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